The Evolution & Outcomes of Total Wrist Arthroplasty: Current Concepts

Over the last several decades, total wrist arthroplasty design and outcomes have significantly improved. The development of modern wrist arthroplasty began in the 1960s with a silicone spacer implant, which has progressively evolved to the metal-on polyethylene modular implants utilized today. Modern implants have been shown to have high patient satisfaction and increased 5-10 year survivorship; however, the overall utilization of total wrist arthroplasty has decreased in the United States since 2001. This could be due to several reasons, including improved modern therapies for rheumatoid arthritis preventing end-stage wrist disease, reliable outcomes with arthrodesis, and the high complication and revision rates of early total wrist implants. This review will discuss the design evolution of total wrist implants, which can be divided into four distinct generations. This review also presents the most recent outcome, complication, and survivorship results for the modern 4th generation of total wrist implants.